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  • Print publication year: 2004
  • Online publication date: December 2009

5 - Cannabis and psychosis proneness


In many countries, a large proportion of the general population is now exposed to cannabis, as a result of its widespread recreational use (Webb et al., 1996; Smart and Ogborne, 2000). From a public health point of view, a careful assessment of the impact of cannabis on mental health in general-population subjects is thus warranted, in order to decide whether prevention strategies aimed at reducing exposure to this drug are justified. Investigation of the mental health characteristics of cannabis users in the general population is especially important for identification of a potential aetiological risk factor for severe mental illness. Converging findings obtained by prospective population-based cohort studies suggest that cannabis use may be an independent risk factor for the onset of psychosis (Andreasson et al., 1987; Arseneault et al., 2002; van Os et al., 2002; Weiser et al., 2002).

However, the nature of the link between cannabis use and psychosis is far from being elucidated. Findings drawn from clinical samples of subjects identified as cases of psychosis have limited value in shedding light on the mechanisms underlying this association, as the potential confounding factors linked to the clinical status of the subjects are difficult to control in such samples. Thus, studies exploring factors modulating the expression of psychosis in non-clinical populations may better identify causal risk factors for psychosis than studies carried out in clinical samples (Verdoux et al., 1998b, van Os et al., 2000; 2001; Verdoux and van Os, 2002).

Allebeck, P, Adamsson, C, Engstrom, A. and Rydberg, U. (1993). Cannabis and schizophrenia: a longitudinal study of cases treated in Stockholm County. Acta Psychiatr. Scand., 88, 21–24
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. Washington, DC: American Psychiatric Association
Amorin, P, Lecrubier, Y, Weiller, E, Hergueta, T. and Sheehan, D. (1998). DSM-III-R psychotic disorders: procedural validity of the MINI International Neuropsychiatric Interview (MINI). Concordance and causes for discordance with the CIDI. Eur. Psychiatry, 13, 26–34
Andreasson, S, Allebeck, P, Engstrom, A. and Rydberg, U. (1987). Cannabis and schizophrenia. A longitudinal study of Swedish conscripts. Lancet, 2, 1483–1486
Arndt, S, Tyrrell, G, Flaum, M. and Andreasen, N. C. (1992). Comorbidity of substance abuse and schizophrenia: the role of pre-morbid adjustment. Psychol. Med., 22, 379–388
Arseneault, L, Cannon, M, Poulton, al. (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. Br. Med. J., 325, 1212–1213
Ashton, C. (2001). Pharmacology and effects of cannabis: a brief review. Br. J. Psychiatry, 178, 101–106
Castle, D. J. and Ames, F. R. (1996). Cannabis and the brain. Aust. NZ J. Psychiatry, 30, 179–183
Chapman, L, Chapman, J, Kwapil, T, Eckblad, M. and Zinser, M. (1994). Putatively psychosis-prone subjects 10 years later. J. Abnormal Psychol., 103, 171–183
Claridge, G. (1997) Theoretical background and issues. In: Schizotypy. Implications for Illness and Health, ed. G. Claridge, pp. 3–18. Oxford: Oxford University Press
Claridge, G. and Beech, T. (1995) Fully and quasi-dimensional constructions of schizotypy. In Schizotypal Personality, ed. A. Raine, T. Lencz and S. A. Mednick, pp. 192–216. Cambridge: Cambridge University Press
Csikszentmihalyi, M. and Larson, R. (1987). Validity and reliability of the Experience-Sampling Method. J. Nerv. Ment. Dis., 175, 526–536
Delespaul, P. (1995) Assessing Schizophrenia in Daily Life. Maastricht: Universitaire Press
Dixon, L, Haas, G, Weiden, P. J., Sweeney, J. and Frances, A. J. (1991). Drug abuse in schizophrenic patients: clinical correlates and reasons for use. Am. J. Psychiatry, 148, 224–230
Dumas, P, Saoud, M, Bouafia, al. (2002). Cannabis use correlates with schizotypal personality traits in healthy students. Psychiatry Res., 109, 27–35
Eaton, W, Romanoski, A, Anthony, J. C. and Nestadt, G. (1991). Screening for psychosis in the general population with a self-report interview. J. Nerv. Ment. Dis., 179, 689–693
Hall, W. and Solowij, N. (1997). Long-term cannabis use and mental health. Br. J. Psychiatry, 171, 107–108
Johns, A. (2001). Psychiatric effects of cannabis. Br. J. Psychiatry, 178, 116–122
Kibel, D. A., Laffont, I. and Liddle, P. F. (1993). The composition of the negative syndrome of chronic schizophrenia. Br. J. Psychiatry, 162, 744–750
Kirkpatrick, B, Amador, X. F., Flaum, al. (1996). The deficit syndrome in the DSM-IV field trial: I. Alcohol and other drug abuse. Schizophr. Res., 20, 69–77
Kwapil, T. R. (1996). A longitudinal study of drug and alcohol use by psychosis-prone and impulsive-nonconforming individuals. J. Abnormal Psychol., 105, 114–123
Liraud, F, and Verdoux, H. (2000). Which temperamental characteristics are associated with substance use in subjects with psychotic and mood disorders?Psychiatry Res., 93, 63–72
Mason, G, Claridge, G. and Jackson, M. (1995). New scales for the assessment of schizotypy. Personal. Individ. Differ., 18, 7–13
Mathers, D. C. and Ghodse, A. H. (1992). Cannabis and psychotic illness. Br. J. Psychiatry, 161, 648–653
McGuire, P. K., Jones, P, Harvey, al. (1995). Morbid risk of schizophrenia for relatives of patients with cannabis-associated psychosis. Schizophr. Res., 15, 277–281
Mueser, K. T., Yarnold, P. R., Levinson, D. al. (1990). Prevalence of substance abuse in schizophrenia: demographic and clinical correlates. Schizophr. Bull., 16, 31–56
Myin-Germeys, I, Delespaul, P. and Vries, M. (2001a). The context of delusional experiences in the daily life of patients with schizophrenia. Psychol. Med., 31, 489–498
Myin-Germeys, I, Os, J, Schwartz, J, Stone, A. and Delespaul, P. (2001b). Emotional reactivity to daily life stress in psychosis. Arch. Gen. Psychiatry, 58, 1137–1144
Nunn, J, Rizza, F. and Peters, E. R. (2001). The incidence of schizotypy among cannabis and alcohol users. J. Nerv. Ment. Dis., 189, 741–748
Peralta, V. and Cuesta, M. J. (1992). Influence of cannabis abuse on schizophrenic psychopathology. Acta Psychiatr. Scand., 85, 127–130
Peters, E. R., Joseph, S. A. and Garety, P. A. (1999). Measurement of delusional ideation in the normal population: introducing the PDI (Peters et al. Delusions Inventory). Schizophr. Bull., 25, 553–576
Poulton, R, Caspi, A, Moffitt, al. (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorder. Arch. Gen. Psychiatry, 57, 1053–1058
Raine, A. (1991). The SPQ: a scale for the assessment of schizotypal personality based on DSM-III-R criteria. Schizophr. Bull., 17, 556–563
Salyers, M. and Mueser, K. (2001). Social functioning, psychopathology, and medication side effects in relation to substance use and abuse in schizophrenia. Schizophr. Res., 48, 109–123
Selten, J. P., Gernaat, H. B., Nolen, W. A., Wiersma, D. and Bosch, R. J. (1998). Experience of negative symptoms: comparison of schizophrenic patients to patients with a depressive disorder and to normal subjects. Am. J. Psychiatry, 155, 350–354
Skosnik, P. D., Spatz-Glenn, L. and Park, S. (2001). Cannabis use is associated with schizotypy and attentional disinhibition. Schizophr. Res., 48, 83–92
Slade, M, Phelan, M, Thornicroft, G. and Parkman, S. (1996). The Camberwell Assessment of Need (CAN): comparison of assessments by staff and patients of the needs of the severely mentally ill. Soc. Psychiatry Psychiatric Epidemiol., 31, 109–113
Smart, R. and Ogborne, A. (2000). Drug use and drinking among students in 36 countries. Addict. Behav., 25, 455–460
Stefanis, N, Hanssen, M, Smyonis, al. (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychol. Med., 32, 347–358
Swendsen, J. D. and Norman, S. (1998). Preparing for community violence: mood and behavioral correlates of the second Rodney King verdicts. J. Traumatic Stress, 11, 57–70
Swendsen, J. D., Tennen, H, Carney, M. al. (2000). Mood and alcohol consumption: an experience sampling test of the self-medication hypothesis. J. Abnormal Psychol., 109, 198–204
Tennant, F. S. Jr and Groesbeck, C. J. (1972). Psychiatric effects of hashish. Arch. Gen. Psychiatry, 27, 133–136
Thornicroft, G. (1990). Cannabis and psychosis. Is there epidemiological evidence for an association?Br. J. Psychiatry, 157, 25–33
Tien, A. (1991). Distributions of hallucinations in the population. Soc. Psychiatry Psychiatric Epidemiol., 26, 287–292
Tramèr, M, Carroll, D, Campbell, al. (2001). Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. Br. Med. J., 323, 16
Os, J, Verdoux, H, Maurice-Tison, al. (1999). Self-reported psychosis-like symptoms and the continuum of psychosis. Soc. Psychiatry Psychiatric Epidemiol., 34, 459–463
Os, J, Hanssen, M, Bijl, R. and Ravelli, A. (2000). Strauss (1969) revisited: a psychosis continuum in the general population?Schizophr. Res., 45, 11–20
Os, J, Hanssen, M, Bijl, R. V. and Ravelli, A. (2000). Strauss (1969) revisited: a psychosis continuum in the general population?Schizophrenia Research, 45, 11–20
Os, J, Hanssen, M, Bijl, R. and Vollebergh, W. (2001). Prevalence of psychotic disorder and community level of psychotic symptoms. Arch. Gen. Psychiatry, 58, 663–668
Os, J, Bak, M, Hanssen, al. (2002). Cannabis and psychosis: a longitudinal population-based study. Am. J. Epidemiol., 156, 319–327
Venables, P, Wilkins, S, Mitchell, D, Raine, A. and Bailes, K. (1990). A scale for the measurement of schizotypy. Personality Individ. Differ., 11, 481–495
Verdoux, H. and Os, J. (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophr. Res., 54, 59–65
Verdoux, H, Maurice-Tison, S, Gay, al. (1998a). A survey of delusional ideation in primary care patients. Psychol. Med., 28, 127–134
Verdoux, H, Os, J, Maurice-Tison, al. (1998b). Is early adulthood a critical developmental stage for psychosis proneness? A survey of delusional ideation in normal subjects. Schizophr. Res., 29, 247–254
Verdoux, H, Os, J, Maurice-Tison, al. (1999). Increased occurrence of depression in psychosis-prone subjects. A follow-up study in primary care settings. omp. Psychiatry, 40, 462–468
Verdoux, H, Gindre, C, Sorbara, F, Tournier, M. and Swendsen, J. (2003a). Cannabis use and the expression of psychosis vulnerability in daily life. Psychol. Med., 33, 23–32
Verdoux, H, Sorbara, F, Gindre, C, Swendsen, D. and Os, J. (2003b). Cannabis and dimensions of psychosis in a non-clinical population of female subjects. Schizophr. Res., 59, 77–84
Webb, E, Ashton, C, Kelly, P. and Kamali, F. (1996). Alcohol and drug use in UK university students. Lancet, 348, 922–925
Weiser, M, Reichenberg, A, Rabinowitz, al. (2002). Self-reported drug abuse in male adolescents with behavioural disturbances, and follow-up for future schizophrenia. Schizophr. Res., 53 (suppl.), 227
Williams, J. H., Wellman, N. A. and Rawlins, J. N. (1996). Cannabis use correlates with schizotypy in healthy people. Addiction, 91, 869–877